| NPI | 1013277300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 28104) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 28104) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2022-03-14 |